I had a question about a screen shot of his lab LDL-C so
I emailed him, and he explained that it was not “Calculated” by the Friedewald
equation but was “Direct.” (The report actually said that; I just missed it.)
He then provided me with a link to a post he wrote a few years ago, Low carbohydrate diets
increase LDL: debunking the myth. This is another post about the effect of Low Carb diets
on TGLs and LDL-C. You’ll need to read to the end of Dr. Mike’s long post to
get to it, so I thought it important to give it a column of its own.

Eades writes about a study in the American Journal of Clinical Nutrition. “This study…demonstrates that subjects following the low-carb diet
experience a decrease in triglyceride levels and an increase in HDL-cholesterol
(HDL) levels; and that these changes are accompanied by a minor increase in
LDL-cholesterol (LDL)…”This
concerns doctors, he says, since “most people who go on low-carb diets do so to
deal with obesity issues, and since obesity is a risk factor for heart disease,
it would appear that this small increase in LDL, often seen in those following
a low-carb diet, could put these dieters at risk.”

So, noting that the benefits to HDL
and triglycerides are offset by “this small increase in LDL-cholesterol seen in
those following a low-carb diet,” Eades wondered how the LDL in the study was
calculated; the “Methods” link in the study provided the answer: the Friedewald
equation: LDL = TC – HDL – TGL/5. IT IS CALCULATED! What’s that you say?
It’s not a DIRECT measurement? No, andevery
standard lab lipid test uses this method.

But, when Friedewald, et al.
developed the formula in 1972, they made an exception for people who had a
triglyceride number >400mg/dl; however, since most people’s test results
were in the 150 – 250mg/dl range, they made no exception for TGL values of
<100mg/dl. And as readers here know, people who follow a Very
Low Carb or LC/HF diet usually have TGLs in the range of 40 – 90mg/dl. The average of my last 50 is 54mg/dl.

So, Eades searched the archives for
scientific papers describing differences between calculated and directly
measured LDL-cholesterol in people with low triglycerides. And lo and behold,
he found two! One was a case presentation where a 63yo man had a TC of 263, an
HDL of 85 and a TGL of 42. The
Friedewald calculated LDL was 170 but it was just 126 when measured directly.
Another paper concluded, “Statistical analysis showed that when triglyceride is
<100mg/dl, calculated LDL is
significantly overestimated (12.17mg/dl average).”

In addition to the over calculation of
LDL cholesterol for low-carbers who have TGLs consistently <100mg/dl, Eades
reminds us that low-carbers typically have the large fluffy, good type of LDL, not
the small, dense type.

Dr. Mike sums this up better than I
could: “The moral of this story is that if you have been following a low-carb
diet and your triglycerides are low (or if your triglycerides are just low) and
your LDL reading comes out a little high – or even a lot high, don’t let anyone
mule you into going on a statin or undergoing any therapy for an elevated
LDL. Demand to have a direct measurement of your LDL done.”

And the coup de grace: “Now when you
hear people say that low-carb diets may help you lose weight but run your LDL
levels up and increase your risk for heart disease, you’ll know this is just so
much gibberish. Sadly, your doctor will probably spout the same thing,
and it will be up to you – who after reading this post will know more about
this point than 99.9 percent of doctors practicing today – to educate
your trained professional.”

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.